CAM 244

COVID-19 Testing

Category:Laboratory   Last Reviewed:July 2020
Department(s):Medical Affairs   Next Review:May 2021
Original Date:May 2020    

Description 
Testing for the COVID-19 virus includes Polymerase Chain Reaction (PCR) testing and serology testing.

Policy 

  • BlueCross BlueShield of South Carolina will cover PCR diagnostic testing for COVID-19, when ordered by an attending health care provider for individuals who are symptomatic and are concerned about infection, for the purpose of identifying and treating active disease.
  • BlueCross BlueShield of South Carolina will cover antigen diagnostic testing for COVID-19, when ordered by an attending health care provider for individuals who are symptomatic and will allow reflex to PCR testing if the antigen test is negative.
  • Serology (antibody) testing will be covered when medically appropriate for an individual, as determined and ordered by the individual's attending health care provider, after an evaluation of the individual and in accordance with accepted standards of current medical practice.
  • Serology (antibody) testing is not to be used as a sole means of diagnosis of COVID-19 infection. 
  • Host antibody serology testing to support a diagnosis of Multisystem Inflammatory Syndrome in Children (MIS-C) meets coverage criteria.
  • PCR testing for asymptomatic members exposed to persons with known COVID-19 with a provider order
  • Preoperative PCR testing with a provider order
  • Serial PCR tests to determine when the infection has abated with provider orders
  • The acquisition of the specimen is integral to the service and is not separately reimbursed.

Rationale
As of 4/29/2020, the Infectious Diseases Society of America (IDSA) noted several facts regarding COVID-19 (also known originally as SARS-CoV-2) testing.  “The current antibody testing landscape is varied and clinically unverified, and these tests should not be used as the sole test for diagnostic decisions.”  Most of the testing available has been approved by FDA with the Emergency Use Authorization (EUA) that does not require the same level of premarketing testing as would typically be required.  The specificity and sensitivity of current tests is quite variable.  The IDSA notes, “A ‘positive’ test is exceptionally difficult to interpret because the performance of these tests is not well known.  

“Further, until more evidence about protective immunity is available, serology (antibody) results should not be used to make staffing decisions or decisions regarding the need for personal protective equipment.” 

The current CDC recommendation notes, “If you test positive, it is unclear if those antibodies can provide protection (immunity) against getting infected again.  This means that we do not know currently if antibodies make you immune to the virus.  If you have symptoms and meet other guidelines for testing, you would need another type of test called a nucleic acid test.  A serologic test alone cannot tell if you definitively have COVID-19.  If you test negative, some people may take even longer to develop antibodies, and some people may not develop antibodies at all.” 

As noted above, FDA has approved through EUA several antibody tests.  It has not approved any direct-to-consumer testing and is concerned about the potential for inaccurate testing results from direct-to-consumer testing.  Any testing a member considers should be prescribed with the knowledge and follow-up of a provider. 

Currently IDSA believes, “antibody tests will be most useful as surveillance tools to estimate (with surrounding confidence intervals) relative proportions of different populations that have been exposed to SARS-CoV-2.  They will have less utility as diagnostic tools for individual patient assessment.” 

“Unlike molecular tests for COVID-19 (e.g., PCR), antibody tests may be better suited for public health surveillance and vaccine development than for diagnosis.”  Additionally, the IDSA believes antibody testing will be important in identifying convalescent plasma donors and potentially in verifying vaccine response once the appropriate antibody correlates are identified. 

The World Health Organization, IDSA and CDC all concur that antibody testing currently has too many variables and unknown performance characteristics to be used as the sole method of either establishing a diagnosis of COVID-19 or confirming immunity.  The true rate of cross-reactivity of antibodies from COVID-19 infections to those antibodies produced by other coronaviruses is unknown.  There are several parts of a coronavirus that can produce antibodies. Which ones are most accurate for predicting recovery and immunity is currently unknown.  It is not known what level of antibodies in a person’s bloodstream is needed to provide immunity, get rid of the virus, and prevent reinfection.  This is important, as individuals who have had a mild case of COVID-19 and initially recover may not develop enough antibody to prevent a future COVID-19 infection.  If antibodies prove to provide immunity, it is not currently known how long that immunity will last. 

There are two types of antibody tests. One is identified as Rapid Detection Testing.  It is a qualitative test and is very similar to a pregnancy test.  The result is either positive, negative or inconclusive, but there is no information in the result about how much antibody a person may have.  The second testing type is Enzyme-Linked Immunosorbent Assay (ELISA).  This is a quantitative test.  The patient’s antibodies to COVID-19 are mixed with a colored substrate that binds to the antibodies.  The result is read with a special instrument that can identify very minor variations in color.  The more intense the color the more COVID-19 antibody is present.  Only this second test can identify the level of antibody a person has but as noted above, it is not currently known what level of antibody is needed protect the person from getting infected again by COVID-19. 

At this time,  CDC is not recommending testing for return to work, except use of SARS-CoV-2 RNA testing (NOT antibody testing) as part of an optional test-based strategy for health care workers who are confirmed or suspected of previously having COVID-19.  The CDC criteria for laboratory testing notes that the decision for testing should be made by a clinician on a patient-by-patient basis and that testing should be performed on symptomatic patients.  It notes, however, that "persons without symptoms in certain situations" might be considered for testing.  The Federal Department of Labor OSHA guidance for preparing workplaces for COVID-19 does NOT include antibody or antigen testing in its guidance for the workplace. 

The CDC notes that with a positive antibody test for COVID-19, "it’s unclear if those antibodies can provide protection (immunity) against getting infected again." A negative antibody test could mean you have a current infection and could still spread the virus and CDC specifically notes: "these test results alone do not confirm if you are able to spread the virus that causes COVID-19."  As such, we do not feel that it is in the best interest of the workforce or public health to promote and perform these tests except on a case-by-case basis with decisions made by a clinician actively caring for the patient. 

References

  1. FDA. Policy for Diagnostic Tests for Coronavirus Disease-2019 during the Public Health Emergency. 2020; https://www.fda.gov/media/135659/download.  Accessed 4/21/2020. 
  2. Infectious Diseases Society of America.  IDSA COVID-19 Antibody Testing Primer, updated April 29, 2020. 
  3. CDC. Coronoavirus Disease 2019 (COVID-19); https://www.cdc.gov/coronavirus/2019-ncov/faq.html. Accessed 5/4/2020. 

Coding Section  

Code

Number

Description

CPT

86328

severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease (COVID-19))

 

86413 

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative 

 

86769

Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease (COVID-19))

 

87426 

Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 (COVID-19)). 

 

87631

Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types of subtypes, 3-5 targets

 

87632

Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types of subtypes, 6-11 targets

 

87633

Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types of subtypes, 12-25 targets

 

87635

Infectious agent detection by nucleic acid (DNA or RNA); severe acute respirator syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease (COVID-19), amplified probe technique

 

0098U

Respiratory pathogen, multiplex reverse transcription and multiplex amplified probe technique, multiple types or subtypes, 14 targets (adenovirus, coronavirus, human metapneumovirus, influenza A, influenza A subtype H1, influenza A subtype H3, influenza A subtype H1-2009, influenza B, parainfluenza virus, human rhinovirus/enterovirus, respiratory syncytial virus, Bordetella pertussis, Chlamydophila pneumoniae, Mycoplasma pneumoniae)

 

0099U

Respiratory pathogen, multiplex reverse transcription and multiplex amplified probe technique, multiple types or subtypes, 20 targets (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus, coronavirus OC43, human metapneumovirus, influenza A, influenza A subtype, influenza A subtype H3, influenza A subtype H1-2009, influenza, parainfluenza virus, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, human rhinovirus/enterovirus, respiratory syncytial virus, Bordetella pertussis, Chlamydophila pneumonia, Mycoplasma pneumoniae)

 

0100U

Respiratory pathogen, multiplex reverse transcription and multiplex amplified probe technique, multiple types or subtypes, 20 targets (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus, human rhinovirus/enterovirus, influenza A, including subtypes H1, H1-2009, and H3, influenza B, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, respiratory syncytial virus, Bordetella parapertussis [IS1001], Bordetella pertussis [ptxP], Chlamydia pneumoniae, Mycoplasma pneumoniae)

 

0202U 

Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected 

 

0223U 

Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected 

 

0244U 

Antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease (COVID-19), includes titer(s), when performed

(Do not report 0224U in conjunction with 86769) 

ICD-10 CM 

Z03.818

Encounter for observation for suspected exposure to other biological agents rulled out.

 

Z20.828

CONTACT WITH AND (SUSPECTED) EXPOSURE TO OTHER VIRAL COMMUNICABLE DISEASES

 

Z11.59

Encounter for screening for other viral diseases

 

B9729

Other coronavirus as the cause of diseases classified elsewhere

 

U071

COVID-19

Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each Policy. They may not be all-inclusive. 

This medical policy was developed through consideration of peer-reviewed medical literature generally recognized by the relevant medical community, U.S. FDA approval status, nationally accepted standards of medical practice and accepted standards of medical practice in this community, Blue Cross and Blue Shield Association technology assessment program (TEC) and other non-affiliated technology evaluation centers, reference to federal regulations, other plan medical policies, and accredited national guidelines.

"Current Procedural Terminology © American Medical Association.  All Rights Reserved" 

History From 2019 Forward     

09/14/2020 

Update coding. Adding code 86413 to coding section. No other changes made. 

08/25/2020 

Interim review, updating verbiage regarding PCR testing, adding verbiage regarding antigen testing, adding verbiage regarding specimen acquisition, and removing G2023 and G2024 from coding. 

07/01/2020 

Interim review to add new coding to coding grid: 87426, 0223U and 0224U. 

06/18/2020 

Interim review to add coverage for PCR testing in the following individuals: asymptomatic members exposed to persons with known COVID-19, preoperative testing and serial testing to determine when the infection has abated. 

06/11/2020 

Interim review to add: Host antibody serology testing to support a diagnosis of Multisystem Inflammatory Syndrome in Children (MIS-C) meets coverage criteria. No other changes made. 

06/09/2020 

Corrected typo in last paragraph. No other changes. 

05/28/2020 

Adding code 0202U to the coding section. No other changes made. 

05/15/2020

Updated coding

05/06/2020

New Policy


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